Cosmetic, elective and women’s surgery

Elective surgery was only a concept in the Greek tradition that Northern Europe didn’t learn until the late medieval, when textbook education about surgery spread north from Bologna. I’m still not sure if the Greek world had been using opium as a surgical pain treatment, but the existence of elective surgery at all seems to imply it.

Paul of Aegina described surgery for nose polyps and ankyloglossia, the “tongue-tied” condition restricting the tongue’s motion. Removing tonsils was a bit more involved than those, but still fairly easy since no incision was needed. His method only needed a few special curved knives, and two strong assistants to hold the mouth open and the tongue down. An eyelid that got flipped in the wrong direction could also be corrected; there were several other corrective eye surgeries.

One of the surprising elective surgeries he describes is breast reduction for boys. It’s clearly the same technique that’s still used today, but of course, the young man had to really want the reduction in order to steel himself for such a procedure without real pain control.

There’s no suggestion that anyone did breast reduction for women, although the same book describes enough obstetrical and gynecological procedures that, when it was translated into Arabic, it was taken for the definitive book on gynecology. The author became known in Arabic as “al-Qawabilly” or “The Gynecologist.” If Paul of Aegina didn’t talk about it, it didn’t exist (to the distress of some women in labor who had feet-first babies that Paul just forgot to mention).

I was surprised to find that this older, more sophisticated medical tradition also included two instruments not known to Europe’s Middle Ages: the catheter and the speculum. The catheter was apparently a metal tube, so that the doctor had to work carefully following the curves of inner anatomy. The speculum was essentially no different from the one used today: two bronze leaf-shaped blades with a screw that forced them to move apart once inside. We use flexible plastic and stainless steel as materials now, instead of silver and bronze, but not much else has changed.

The barbarian invasions that began in the 200s and continued, in waves, into the 12th century, seem to explain why this sophisticated knowledge was not available to medieval Europe. It was preserved and improved in Greek-speaking Constantinople, then transferred to the schools and courts of Damascus, Baghdad and Cordoba. We don’t see surgery textbooks showing up in Paris until the late medieval period.